How an 'Uber for pregnant women' is saving lives in Tanzania

When 28-year-old Consolata went into labor in rural Sengerema, Tanzania, it was by no means picture-perfect. She was extremely fatigued, and soon started experiencing intense pain.

"I was in bad shape," she said. "I couldn't do anything because I was tired."

Without knowing exactly what was wrong, she knew she needed to get to a clinic immediately — for her baby's health and her own. But Consolata's district, with a population of 500,000 people, has only three ambulances. Getting to a doctor in time seemed impossible.

So she took out her mobile phone and dialed a special hotline number to get an "ambulance taxi" — a revolutionary aspect of the Vodafone Foundation's maternal health program in Tanzania's rural Lake Zone. Health workers connect pregnant women in emergencies to a local network of vetted taxi drivers, who are paid via the popular mobile money system M-Pesa to pick them up and get them to clinics, fast.

"I thought my baby and I were going to die."

One of these cars brought Consolata to her nearest clinic, where she gave birth to a healthy baby boy named Kurwa. But her doctors examined her and found the cause of her severe pain: she was unknowingly carrying another baby. She needed to be relocated to a hospital in Shinyanga, but with still no ambulances available, they called another taxi through Vodafone's service.

"I thought my baby and I were going to die," Consolata said, in a video detailing her story.

She gave birth to her second baby in the back seat; when she finally arrived at the hospital, she was hemorrhaging, but recovered after a few days.

Because of the time saved with the ambulance taxi service, which has been likened to an "Uber for emergencies," Consolata and her twins survived. And it's just one example of the first-of-its-kind program's impact, now saving the lives of 200 mothers and infants in Tanzania every month.

Since it launched late last year in the districts of Sengerema and Shinyanga, the ambulance taxi service has helped 3,523 women in emergencies, either while in labor or experiencing complications in the middle of their pregnancies. There are more than 130 drivers currently in the network. In contrast, only 10 traditional ambulances exist between the two districts, which have a combined population of 2 million.

According to Andrew Dunnett, director of the Vodafone Foundation, 90 percent of maternal health emergencies in those districts are now managed by the ambulance taxis.

"We've seen an 80 percent decrease in the number of fatalities in pregnant women being transported during emergencies," Dunnett said, comparing it to women in these districts using traditional ambulances. "So, we've seen a dramatic reduction, which translates to 200 lives saved a month — mothers and newborns — within just two districts that are on the program."

It's all part of a goal, he said, to use mobile technology that gets pregnant women in some of the deepest rural communities access to lifesaving treatment.

A "mobilizing maternal health" poster is put up in every health clinic with information about a toll-free hotline for emergency transport.

Image: Courtesy of Vodafone Foundation

In Tanzania, the number of women who die during pregnancy and childbirth — 454 deaths per 100,000 births — is among the highest in the world. Even though the government has made commitments to help, maternal death rates haven't decreased in seven years. And more than 36 million people in the country (70 percent of its total population) live in rural areas with limited access to basic health services.

"She lived with obstetric fistula for over 30 years. Which is just unbelievable. It just shouldn't happen."

The Vodafone Foundation started to help, financially, in 2010, supporting a charity hospital called Comprehensive Community Based Rehabilitation in Tanzania (CCBRT) in the city of Dar es-Salaam. The hospital shed light on a longstanding problem: every year, Tanzania sees an estimated 3,000 new cases of obstetric fistula, a condition that leaves a woman incontinent because of prolonged, obstructed labor. Many of these women have no access to C-sections, a midwife, or a clinic.

"I remember meeting a lady, and I asked the interpreter how old she was," Dunnett said. "She was in her 70s, and she lived with obstetric fistula for over 30 years. Which is just unbelievable. It just shouldn't happen."

So, as a corporate foundation, they wanted to move away from simply writing checks and use the company's expertise in mobile technology to prevent the problem, rather than cure it.

With the support of partners such as USAID, Pathfinder International, and the Touch Foundation, Vodafone launched its $5 million "Mobilising Maternal Health Program." One of its main features is a customized mobile app to educate 250 community health workers, and help them pinpoint women who might benefit from the program. To date, 46,000 pregnant women are enrolled, so health workers are aware of who they are and the women are aware of services available to them. The program also trains health care providers, and includes dedicated efforts to improve health facilities.

Omari Mabula drives a taxi that helps get pregnant women to clinics through a new maternal health program.

Image: Sala Lewis / Vodafone Foundation

But the cornerstone of the program is the ambulance-taxi service and the accompanying 24-hour toll-free maternal emergency hotline. A pregnant woman can call, and a health worker will identify the emergency and dispatch one of the ambulance-taxis to her location via GPS.

Each driver is a local taxi driver who knows the area well, and is carefully interviewed, selected, and informed of their special role. One of the biggest incentives is that they each receive a sizable $40 fare — they get half when they pick someone up and the other half when they safely deliver her to the hospital.

"I think the beauty of it is that it's a simple program."

The service is completely free of charge for the pregnant women; all fares are paid via M-Pesa through the program. At $40 per fare, that's only about $140,000 for payments to help pregnant women so far, making it an extremely cost-effective solution.

"I think the beauty of it is that it's a simple program," Dunnett said. "It's based upon mobile money, which is pretty much universal in parts of Kenya and Tanzania. I think the benefit is that the taxi drivers are very keen on the service. Remember, a $40 fare is a huge fare ... I think that's another critical factor of why it works."

The drivers don't have any specific health training — their role is solely geographic in scope, cutting down the travel time that women in rural Tanzania often face. (Dunnett said a woman's journey to a hospital could be a two to three days' walk while in labor or, "if they're lucky," one day on the back of a bike.)

But many women will already be traveling with a local community health worker or midwife. The cars are also equipped with compression belts, which can stop hemorrhaging on a long drive to a hospital, drastically increasing a woman's chances of survival.

There are, of course, some obstacles. Mobile coverage can be spotty in especially remote areas, and the rainy season makes rural roads particularly difficult to trek and reach women in need.

But the transportation service's existence alone has had a proven, tangible impact on the lives of women and newborns. Now, the biggest challenge is to bring it to scale. The Vodafone Foundation is looking at another 10 districts to bring the program to, but they want to make sure they get it right first.

"For us, the real challenge is to scale it up into the next 10 districts, to learn everything we can, and then to find a sustainable commercial model for this," Dunnett said, explaining that it needs to go beyond philanthropy. "That's critical for a long-term, successful intervention."

Rehema Sanane, 30, holds her baby in Sengerema, Tanzania, in March 2016.

Image: Sala Lewis / Vodafone Foundation

Dunnett also said you can't just simply bring technology and expect it to solve the problem — it's a matter of strengthening the health care system itself in Tanzania. If a woman is picked up by a taxi and taken to a clinic where there aren't adequate services, you're not really helping the situation. Infrastructure work is crucial to enable the system to work effectively.

"I think the potential of the program is extraordinary," he said. "I think the innovation of using mobile technology to turn these vehicles that are already there into ambulances is very simple but, as you can see, very impactful."

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